as they are—address only the surface of psychological life. Successful treatment outcomes are defined by a reduction in symptoms. Insurance companies want to see quick results, and we do, too. We are seduced by the allure of seven-steps-to-happiness and feel-better-in-ten-sessions-or-less.
But such techniques do not lead to real, lasting change.
Years ago when Shaquille O’Neal was at the height of his basketball career as the center for the Los Angeles Lakers, he spent a great deal of time at the free throw line because he was intentionally fouled so much. Free throws were his weakness, and the other teams knew it. It was a bit painful to watch this enormous and enormously talented athlete shoot the ball so flat from the free throw line, missing shot after shot after shot. I’ll never forget when local legend and sportscaster Chick Hearn analyzed the situation. He said that Shaq could not be faulted for failing to practice; in fact, he practiced his foul shot for hours, each and every day. Chick Hearn commented that the problem was that he kept practicing the same shot. No matter how much you practice, he said, you can’t change if you have a flawed technique.
Just like Shaq, we need a fundamental and deep transformation. Doing the same thing over and over again won’t lead to a different outcome. A surface adjustment isn’t going to cut it. If we want to make deep changes, we have to go deep to make them. We have to get to the root of the problem, the heart of the insanity. We have to go below the tip of the iceberg. We need an approach that appreciates the powerful influence of the unconscious. The good news is that if we change at this deep level, the surface changes will follow.
Much of what I want to show you in these pages requires an open mind. The unconscious is difficult to grasp, both as a concept and in its real influence in our lives. It can’t be measured in a direct way. It isn’t particularly well suited for study in a laboratory. It is known only through inference. It is grasped only by deduction. It is like gravity. You can’t see it or touch it, but you know it is real because its effects are real.
So I say to you, the reader, what I say to my students and patients: I can’t prove anything about the unconscious to you. I can only show you what I see; it is up to you to decide if it makes sense and if it could be useful to you.
Understanding how the unconscious mind works requires careful study. We must look for patterns, trends, and repetitions so we can get the big picture. But the devil is also in the details, as they say—in the slip of the tongue, in the unintended revelation, and in the dream that haunts us at night. Understanding the unconscious mind requires imagination, intuition, and investigation. It is both science and art. We hear the unconscious not only in the words, but also in the music. We pay attention to what is there, but we also notice what is missing. We must play with ideas rather than be bound by them. We really have to think. We have to be open to the truth conveyed in the saying that there comes a time when the mind takes a higher plane of knowledge but it can never prove how it got there.
Every year, I teach a course on psychoanalytic theory and technique to graduate students in clinical psychology. In the first session, I try to engage the students in a lively way by asking them about how we know that there even is such a thing as the unconscious. Now, these are doctoral students trained in the ways of modern scientific psychology. They can be a bit constrained when it comes to imaginative thinking. But because this is an elective course they are not required to take, those who sign up often have some openness and curiosity about the deeper layers of the mind. So they are usually willing to play with the question and often come up with some pretty good answers.
The students’ first response often involves the idea that we know about the unconscious through dreams. I once thought that this was an easy, textbook kind of answer, but I have come to believe that it is actually a more fascinating response than it might seem at first glance. After all, one could say that dreams are meaningless brain activity, a necessary physiological process to clear out the mental junk from the day. But we intuitively know that there is more to dreams than can be measured on an EEG machine. Dreams are personal. Dreams mean something.
Take, for example, the dream of a man in his first week of psychoanalysis. I heard about this case many years ago from one of my professors who used it as an illustration in one of his classes. (Please be advised that clinical material from actual patients is used sparingly throughout this book. Confidentiality and privacy have been protected by changing or omitting identifying information.) The patient was a mental health professional in his forties who had wanted to have an analysis for many years and felt that he really needed some help. But for a variety of reasons—some circumstantial and some of a yet-to-be-discovered psychological nature—he hadn’t been able to bring himself to do it. He was very pleased to have the opportunity to begin therapy with my professor, a well-regarded female Kleinian analyst. The patient had studied Freud and Klein in school, so he felt he had an idea of what the process of analysis would be like and was eager to begin. In the second session, he shared the following dream:
It was late at night and I was in bed; my wife and two children were asleep. I heard some noise in the bathroom, so I got up and went to check it out. I looked out the bathroom window and there was a woman on the roof, trying to break into the house. She was dressed in black with a hood over her face. It was clear that she was going to try to rob the house. I was terrified that she was going to harm my family. I cannot remember ever feeling so angry in my life. I reached through the window and grabbed the woman around the neck. I pulled her in and wrestled her to the floor. I was kicking her so hard that I thought I might actually kill her. But at some point, I realized that she was not fighting back. She was telling me to stop. So I stepped back and pulled the hood off her face. I was shocked because the woman was a friend of mine from high school, a person I had liked but had not been particularly close to. Her name was Melanie.
Freud called dreams “the royal road to the unconscious,” and if there was ever a royal road, this is it. I am hoping that the meaning of the dream is fairly obvious to you. It is a good teaching dream, because the elements are pretty straightforward. Even as students ourselves, when we heard the dream for the first time, my classmates and I were able to grasp some of its meaning.
If we keep the context in mind—that this is the very first dream in the very first week of therapy—would it be too much of a stretch to consider that the man is dreaming about his anxiety in beginning therapy? Can you see that he is letting us know that he is utterly terrified that the therapist (the black-hooded woman) will be a dangerous intruder, robbing him and hurting him in the most intimate and vulnerable of places (in the bathroom, potentially harming his family)? Can you see that his unconscious mind is revealing that he is going to fight against this intrusion with all his might? Perhaps this dream helps us understand why he put off therapy for so long, even though he consciously wished to have it and knew he needed it. Beneath the surface, he is frightened of what will be taken from him and of what will be done to him. He also might be frightened of what might be revealed about him—how aggressive and defensive he can become.
One of the most fascinating aspects about this story is that the patient was totally shocked by this dream and had no idea what it meant. He could not relate to his intense level of fear and aggressiveness, so out of character for him as he consciously knew himself at the time. He didn’t link the dream to his attitudes about his new analyst, even with the marvelous tip-off that the intruder’s name was Melanie. (Remember, the man had studied Klein, he knew that the analyst was Kleinian, and Klein’s first name was Melanie. Dream symbols are often quite funny.) He didn’t put together that he was dreaming about how frightened he was that the analyst would violently intrude into his psychic life and that he would fight against this intrusion to the edge of death. To me, the fact that he didn’t have a clue about the meaning of the dream is another way of seeing this man’s unconscious mind at work. Blind spots hide some of the deepest truths.
My professor told us that this man went on to have a turbulent but profitable analysis. He was open to his unconscious experience, and that proved to be a great help to him—once he got someone else
